Identifying behaviours for survival and wellness among people who use methamphetamine with opioids in British Columbia: a qualitative study

Abstract

Background British Columbia (BC) has been in a state of public health emergency since 2016, due to the unprecedented numbers of fatal and non-fatal drug toxicity (i.e. overdose) events. Methamphetamine detection in illicit drug toxicity deaths increased from 14% in 2012 to 43% in 2020 suggesting a concerning trend of concurrent methamphetamine and opioid use in BC, consistent with rising patterns identified across North America. People who use methamphetamine concurrently with opioids face an elevated risk of harm. This study aimed to identify behaviours for survival and wellness practiced by people who concurrently use methamphetamine and opioids. Methods One-on-one semi-structured interviews were conducted by peer research assistants in person and by telephone. Thematic analysis was carried out to identify patterns in behaviours participants described as important to their safety in the context of concurrent use of methamphetamine and opioids. Results Participants (n = 22) were distributed across the province with at least four participants from each of the five geographic health regions: 64% self-identified as men, and 50% self-identified as Indigenous. Daily methamphetamine use was reported by 72.7% of participants, and 67.3% reported using alone either often or always. Participants made several considerations and adaptations in order to balance the perceived benefits and risks of their use of methamphetamine with opioids. Two overarching themes were identified to describe how participants adapted their use for survival and wellness. The first was personal safety behaviours which included self-regulation and self-care behaviours. The second was interpersonal safety behaviours which included using alongside peers, and engaging with peer-led services (e.g. community outreach organizations) and public health-led services (e.g. overdose prevention sites) to reduce the risk of harm. Participants identified many gaps in available services to meet their diverse needs. Conclusions This manuscript identified diversity in participants’ methamphetamine and opioid use (i.e. frequency, route of administration), and a range of behaviours that were performed to improve wellness and survival while using methamphetamine and opioids. Harm reduction and treatment responses must be robust and adaptable to respond to the diversity of patterns of substance use among people who use methamphetamine and opioids concurrently, so as to not perpetuate harm and leave people behind.

“It’s just a perfect storm”: Exploring the consequences of the COVID-19 pandemic on overdose risk in British Columbia from the perspectives of people who use substances

“…This study consisted of semi-structured, one-on-one interviews conducted by phone or in-person as part of two qualitative studies performed across BC: the Concurrent Use and Transition to Methamphetamine among People at Risk of Overdose (CUT Meth OD) study (n = 27) and the Good Samaritan Drug Overdose Act (GSDOA) evaluation study (n = 35) [28,29]. Qualitative interview guides were developed by the research team -including researchers, people with lived and living experience of substance use, stakeholders from community organizations, health authorities, and young adults.…”

Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey

“…We found that more than 60% of the sample reported the use of both opioids and stimulants, re ecting high rates of co-use of these substances, which have been reported more widely in population-level samples in BC, Canada, and North America(29-33). People are known to have a range of motivations for co-use (34) and to practice strategies to protect from harm (35), nevertheless the risk of harm persists given the rising toxicity of the unregulated drug supply in BC (36). Despite this co-use being common, only 30% of people who received an opioid PSS prescription in this study also received a stimulant PSS prescription.…”

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

“…Nevertheless, recent reporting on illicit drug toxicity deaths in BC found that many people who died had not been previously engaged in SUD treatment, suggesting that the risk of overdose in BC extends beyond people with diagnosed SUDs. 50 As such, cases of death in people with neither diagnosis could represent people who use drugs irregularly, and who do not have the same tolerance nor knowledge and skills 51 , 52 to prevent or reduce overdose risk as people with more experience using drugs, including people with SUDs. Furthermore, some interventions meant to prevent overdose are available in BC for people with OUD that are not available to people without an OUD diagnosis.…”